The management of possible fishbone ingestion

We assessed the usefulness of computed tomography (CT) in cases of suspected impaction of fish bones in the esophagus. The findings of this study were also compared with those of studies in which surgery was used to remove or confirm the presence of fish bones. We accordingly propose a management protocol to ensure optimum outcome for patients with a history of fish bone ingestion.

X-ray and CT imaging were performed in 76 patients in whom esophageal impaction of fish bones was suspected.

Plain X-ray revealed impacted fish bones in 17 patients (22%), soft-tissue swelling but no evidence of foreign body in 5 (7%), and no abnormal findings in 54 (71%). These findings were apparent on CT scans in 31 (41%), 8 (10%), and 37 (49%), respectively. Of the 31 patients in whom CT revealed a fishbone, 17 (55%) also exhibited X-ray evidence of foreign body. Of the remainder, X-ray revealed only soft-tissue swelling in 3 (10%), and was unremarkable in 11 (35%). Among the 5 patients in whom X-ray demonstrated only soft-tissue swelling, CT was positive for foreign body in 3 (60%). Of the 54 patients in whom X-ray appearances were normal, CT revealed foreign bodies in 11 (20%) and other abnormalities in 6 (11%).

In the present study, sensitivity and specificity of plain X-ray was 54.8% (17 of 31) and 100% (45 of 45), respectively. However, for CT, both sensitivity and specificity were 100%. CT was determined to be very useful in the diagnosis of impacted fish bones in the esophagus.